蘑菇来源的多糖在癌症免疫治疗中的应用：机制、人体证据与转化优先级。
完整摘要 · 中文译文
蘑菇来源多糖被广泛宣传为抗癌免疫调节剂，但其解释因产品身份不精确、制剂化学不等同以及跨证据级别外推而受到削弱。本批判性叙述性综述评估β-葡聚糖、杂多糖、多糖-蛋白复合物、粗提组分、修饰衍生物和多组分提取物作为制剂特异性辅助治疗候选物。受体层面证据对一般真菌β-葡聚糖系统最为有力，尤其是Dectin-1/Syk/CARD9信号传导和条件性补体受体3协同；将这些机制直接转移到单个蘑菇制剂需要产品特异性因果检验。选定的动物研究支持髓系重塑、树突状细胞和自然杀伤细胞效应以及T细胞活化，但给药途径、暴露、产品表征和模型局限性制约了转化。人体证据仍异质：既往随机PSK研究报道在特定辅助化疗情境中获益，后来的一项III期香菇多糖试验在总生存方面为阴性，小型舞茸、姬松茸和pleuran研究主要报告免疫替代指标。与检查点抑制剂、治疗性抗体或癌症疫苗相关的直接临床证据尚未确立。因此，该领域应从物种层面的宣称转向产品层面的开发，采用经鉴定的原料、正交结构分析、污染物控制、机制关联效价、给药途径特异性药代动力学、肿瘤药理 动力学，以及针对当代标准治疗的随机化检验。蘑菇来源的多糖免疫调节剂仍然是合理的研究候选物，但无论是该类制剂还是未经标准化的蘑菇食品或补充剂，均未在临床上被验证为既定癌症治疗的替代品。
完整摘要 · 英文原文
Mushroom-derived polysaccharides are widely promoted as anticancer immune modulators, but interpretation is weakened by imprecise product identity, chemically non-equivalent preparations, and extrapolation across evidence levels. This critical narrative review evaluates beta-glucans, heteropolysaccharides, polysaccharide-protein complexes, crude fractions, modified derivatives, and multicomponent extracts as preparation-specific adjunct candidates. Receptor-level evidence is strongest for general fungal beta-glucan systems, particularly Dectin-1/Syk/CARD9 signaling and conditional complement receptor 3 cooperation; direct transfer of those mechanisms to individual mushroom preparations requires product-specific causal testing. Selected animal studies support myeloid remodeling, dendritic-cell and natural-killer-cell effects, and T-cell activation, but route, exposure, product characterization, and model limitations constrain translation. Human evidence remains heterogeneous: historical randomized PSK studies reported benefit in specific adjuvant chemotherapy settings, a later phase III lentinan trial was negative for overall survival, and small maitake, Agaricus, and pleuran studies mainly report immune surrogates. Direct clinical evidence with checkpoint inhibitors, therapeutic antibodies, or cancer vaccines is not established. The field should therefore move from species-level claims to product-level development with authenticated source material, orthogonal structural analysis, contaminant control, mechanism-linked potency, route-specific pharmacokinetics, tumor pharmacodynamics, and randomized testing against contemporary standard care. Mushroom-derived polysaccharide immunomodulators remain plausible research candidates, but neither the class nor unstandardized mushroom foods or supplements are clinically validated substitutes for established cancer treatment.